Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction

被引:199
作者
Stenestrand, Ulf [1 ]
Lindback, Johan
Wallentin, Lars
机构
[1] Univ Hosp, Dept Cardiol, SE-58185 Linkoping, Sweden
[2] Uppsala Univ, Uppslaa Clin Res Ctr, Uppsala, Sweden
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2006年 / 296卷 / 14期
关键词
D O I
10.1001/jama.296.14.1749
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Whether the superior results of percutaneous coronary intervention (PCI) reported in clinical trials in which patients with ST-segment elevation myocardial infarction (STEMI) received reperfusion treatment can be replicated in daily practice has been questioned, especially whether it is superior to prehospital thrombolysis (PHT). Objective To evaluate the outcome of different reperfusion strategies in consecutive STEMI patients. Design, Setting, and Patients A prospective observational cohort study of 26 205 consecutive STEMI patients in the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) who received reperfusion therapy within 15 hours of symptom onset. The registry includes more than 95% of all Swedish patients, of all ages, who were treated in a coronary intensive care unit between 1999 and 2004. Interventions Seven thousand eighty-four patients underwent primary PCI; 3078, PHT; and 16 043, in-hospital thrombolysis (IHT). Main Outcome Measures Mortality, reinfarction, and readmissions as reported in the National Health Registries through December 31, 2005. Results After adjusting for younger age and less comorbidity, primary PCI was associated with lower mortality than IHT at 30 days (344 [4.9%] vs 1834 [11.4%]; hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.53-0.71) and at 1 year (541 [7.6%] vs 2555 [15.9%]; HR, 0.68; 95% CI, 0.60-0.76). Also primary PCI correlated with lower mortality than PHT at 30 days (344 [4.9%] vs 234 [7.6%]; HR, 0.70; 95% CI, 0.58-0.85) and 1 year (541 [ 7.6%] vs 317 [10.3%]; HR, 0.81; 95% CI, 0.69-0.94). Prehospital thrombolysis predicted a lower mortality than IHT at 30 days (HR, 0.87; 95% CI, 0.76-1.01) and at 1 year (HR, 0.84; CI 0.74-0.95). Beyond 2 hours' treatment delay, the observed mortality reductions with PHT tended to decrease while the benefits with primary PCI seemed to remain regardless of time delay. Primary PCI was also associated with shorter hospital stay and less reinfarction than either PHT or IHT. Conclusions In unselected patients with STEMI, primary PCI, which compared favorably with IHT and PHT, was associated with reduced duration of hospital stay, readmission, reinfarction, and mortality.
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页码:1749 / 1756
页数:8
相关论文
共 35 条
[1]   Myocardial infarction redefined -: A consensus Document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction [J].
Alpert, JS ;
Antman, E ;
Apple, F ;
Armstrong, PW ;
Bassand, JP ;
de Luna, AB ;
Beller, G ;
Breithardt, G ;
Chaitman, BR ;
Clemmensen, P ;
Falk, E ;
Fishbein, MC ;
Galvani, M ;
Garson, A ;
Grines, C ;
Hamm, C ;
Jaffe, A ;
Katus, H ;
Kjekshus, J ;
Klein, W ;
Klootwijk, P ;
Lenfant, C ;
Levy, D ;
Levy, RI ;
Luepker, R ;
Marcus, F ;
Näslund, U ;
Ohman, M ;
Pahlm, O ;
Poole-Wilson, P ;
Popp, R ;
Alto, P ;
Pyörälä, K ;
Ravkilde, J ;
Rehnquist, N ;
Roberts, W ;
Roberts, R ;
Roelandt, J ;
Rydén, L ;
Sans, S ;
Simoons, ML ;
Thygesen, K ;
Tunstall-Pedoe, H ;
Underwood, R ;
Uretsky, BF ;
Van de Werf, F ;
Voipio-Pulkki, LM ;
Wagner, G ;
Wallentin, L ;
Wijns, W .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (03) :959-969
[2]   A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction [J].
Andersen, HR ;
Nielsen, TT ;
Rasmussen, K ;
Thuesen, L ;
Kelbaek, H ;
Thayssen, P ;
Abildgaard, U ;
Pedersen, F ;
Madsen, JK ;
Grande, P ;
Villadsen, AB ;
Krusell, LR ;
Haghfelt, T ;
Lomholt, P ;
Husted, SE ;
Vigholt, E ;
Kjaergard, HK ;
Mortensen, LS .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 349 (08) :733-742
[3]  
Betriu A, 1997, NEW ENGL J MED, V336, P1621
[4]   Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with ST-elevation myocardial infarction [J].
Björklund, E ;
Stenestrand, U ;
Lindbäck, J ;
Svensson, L ;
Wallentin, L ;
Lindahl, B .
EUROPEAN HEART JOURNAL, 2006, 27 (10) :1146-1152
[5]   Prehospital diagnosis and start of treatment reduces time delay and mortality in real-life patients with STEMI [J].
Björklund, E ;
Stenestrand, U ;
Lindbäck, J ;
Svensson, L ;
Wallentin, L ;
Lindahl, B .
JOURNAL OF ELECTROCARDIOLOGY, 2005, 38 (04) :186-186
[6]   Outcome of ST-elevation myocardial infarction treated with thrombolysis in the unselected population is vastly different from samples of eligible patients in a large-scale, clinical trial [J].
Björklund, E ;
Lindahl, B ;
Stenestrand, U ;
Swahn, E ;
Dellborg, M ;
Pehrsson, K ;
Van De Werf, F ;
Wallentin, L .
AMERICAN HEART JOURNAL, 2004, 148 (04) :566-573
[7]   Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients [J].
Boersma, E .
EUROPEAN HEART JOURNAL, 2006, 27 (07) :779-788
[8]   Early thrombolytic treatment in acute myocardial infarction: Reappraisal of the golden hour [J].
Boersma, E ;
Maas, ACP ;
Deckers, JW ;
Simoons, ML .
LANCET, 1996, 348 (9030) :771-775
[9]   Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study [J].
Bonnefoy, E ;
Lapostolle, F ;
Leizorovicz, A ;
Steg, G ;
McFadden, EP ;
Dubien, PY ;
Cattan, S ;
Boullenger, E ;
Machecourt, J ;
Lacroute, JM ;
Cassagnes, J ;
Dissait, F ;
Touboul, P .
LANCET, 2002, 360 (9336) :825-829
[10]   The volume of primary angioplasty procedures and survival after acute myocardial infarction [J].
Canto, JG ;
Every, NR ;
Magid, DJ ;
Rogers, WJ ;
Malmgren, JA ;
Frederick, PD ;
French, WJ ;
Tiefenbrunn, AJ ;
Misra, VK ;
Kiefe, CI ;
Barron, HV .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (21) :1573-1580